Provider Demographics
NPI:1881223816
Name:BENALCAZAR, CARLOS MARCELO
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:MARCELO
Last Name:BENALCAZAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21350 W 153RD ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-5413
Mailing Address - Country:US
Mailing Address - Phone:913-499-8100
Mailing Address - Fax:913-499-8111
Practice Address - Street 1:1202 E 23RD ST STE C
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66046-4103
Practice Address - Country:US
Practice Address - Phone:785-331-4200
Practice Address - Fax:785-311-4455
Is Sole Proprietor?:No
Enumeration Date:2020-04-02
Last Update Date:2020-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS116181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical